What is Selective Mutism?
Selective Mutism (SM) is a childhood anxiety disorder where speaking in unfamiliar, socially demanding, or stressful situations can feel impossible. A child with SM speaks freely and confidently at home but become silent and withdrawn at school, the playground, or even around extended family members.
Children with SM are not shy or defiant. It is a pervasive anxiety disorder that makes verbal communication feel like an overwhelming, if not impossible, task. However, through early intervention, evidence-based treatment, systemic support, your child can learn how to grow their bravery and confidence step by step.
Common Signs
Noticeable differences in your child’s ability to verbally engage with different people and environment.
The questions parents of children with selective mutism (SM) often ask are “Why does my child not talk” or “why do they speak at home but not at school?”. Significant differences in frequency, volume, and ability to speak across environments is often the first sign that your child may have SM.
Blank facial expressions and lack of eye contact
In stressful or socially demanding environments, children with SM often adopt a blank/flat facial expression and may fail to make eye contact (e.g. staring off into space, looking at the floor).
Frequent use of non-verbal communication
Children with SM often find alternative forms of communication. This may include pointing, shaking and nodding of their head, shrugging their shoulders, or even writing or typing notes.
Uncomfortable eating, drinking, and going to the bathroom outside the home
Children with SM are often too anxious to eat, drink, or go to the bathroom outside their of home. During snack or lunch time, you may observe them sitting with their lunch, snack or drink unopened.
Our Approach
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Parent-Child Interaction Therapy adapted for Selective Mutism (PCIT-SM) is the gold-standard treatment for selective mutism. Numerous studies have observed the efficacy of treating children with SM and social anxiety disorder with PCIT-SM.
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Intensive Group Behavioral Therapy (IGBT) is a highly effective treatment program for selective mutism and other anxiety disorders. It is an evidence-based cognitive behavioral therapy. We run a 5-day IGBT program in both Hong Kong and Maine called Confident Crew. For more information about our program, click HERE.
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Exposure and response prevention (ERP) is an evidence-based cognitive behavioral treatment that gently but systematically exposes a child to situations where anxiety is experienced. ERP supports children challenging their usual avoidance response (staying silent, freezing, relying on others to speak for them). Over time, repeated practice in these situations helps the child feel safe and confident to speak. As their anxiety decreases, speaking across environments becomes easier.
For selective mutism specifically, ERP focuses on building speaking behaviors in the settings where a child typically cannot speak, such as school, activities, or with extended family, while protecting the child from being pushed too far, too fast. Treatment is active, structured, and collaborative, and it usually involves parents, teachers, and other key adults as partners in the process
What happens if left untreated?
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Social Impact
Selective mutism can lead to challenges initiating and maintaining social relationships, developing age-appropriate social-emotional skills, and integrating into social environments which are imperative to healthy development.
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Psychological Impact
Children with SM may struggle with self-esteem and self-worth and are more likely to develop other anxiety and mood disorders later in life.
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Academic Impact
Children with SM are more likely to struggle academically, develop school refusal, and school-based phobias.